Practice details
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Patient details
Outpatient details: Ultrasound / Echocardiography
Brief relevant clinical history, including presenting signs and provisional diagnosis:
Questions to be answered by the report:

* Recent blood test results (haematology and biochemistry) MUST be included if contrast is required.*

- Does not have any metal fragments in any body part
- Has not had any surgical intervention involving placement of metal implants, plates, or clips - Does not have any type of electronic, mechanical, or magnetic implant (excluding microchip)
- Has not had any surgery in the past two months
- Is not pregnant

Patient history / Recent blood tests
Please attach patient history and recent blood tests (we need both). Choose a file and then upload it. Repeat process for each file.
Files must be less than 8 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx.
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